Advances in breast surgery in recent decades have dramatically changed the treatment of breast cancer. It's no longer simply the removal of the whole breast (mastectomy), or taking out the "lump" (tumor) in what's known as lumpectomy, or breast conserving surgery.
Now, women have more options made possible by the new multidisciplinary specialty called oncoplastic breast surgery. The term was actually coined in the mid-1990s. Since then, the specialty itself has grown rapidly, in part through demands made by women themselves.
Patients with breast cancer are more informed than ever, and they are encouraging their surgical teams to continue to evolve.
Oncoplastic breast surgery brings together breast surgeons and reconstructive plastic surgeons. It requires a team approach to produce positive long-term oncologic results as well as satisfactory cosmetic and functional outcomes.
Here, two members of our faculty, reconstructive plastic surgeon Tara L. Huston, MD, and breast surgeon Christine R. Rizk, MD, answer frequently asked questions about oncoplastic breast reduction. Both doctors work together often to provide this progressive care at Stony Brook Medicine.
Q: What is oncoplastic breast reduction?
A: Oncoplastic breast reduction is the combination of a traditional lumpectomy with a standard breast reduction. Lumpectomy is the surgical part of breast conservation therapy offered to women who wish to save their breasts and avoid mastectomy in the treatment of their breast cancer.
Breast reduction or reduction mammaplasty is a procedure offered to women with heavy, large breasts (macromastia) who would like a decrease in the size of their breasts to increase their comfort.
Q: Is oncoplastic breast reduction an effective treatment of breast cancer? Have clinical trials been conducted to evaluate its effectiveness?
A: Oncoplastic reduction allows large-breasted women to have the same breast tissue removed as they would with lumpectomy. In addition, the oncoplastic reduction is followed by radiation, just as the traditional lumpectomy would be. There is no compromise in cancer care.
New approaches today are dramatically changing
breast cancer surgery, giving women more options.
Q: How do the long-term results of oncoplastic breast reduction compare with other surgical options, in terms of cancer therapy?
A: In large studies comparing standard breast conservation therapy to oncoplastic reduction, comparable outcomes have been found, demonstrating the equivalent oncologic safety between the two. The difference is in the cosmetic satisfaction, which has been found to be higher in women who undergo this type of immediate reconstruction, as their breast symmetry is much improved.
Q: What are the complications associated with oncoplastic breast reduction?
A: The possible complications are similar to both the lumpectomy and the traditional breast reduction operations. These include bleeding, infection, decrease or increase in nipple sensation, wound healing issues, asymmetry, cosmetic dissatisfaction, and need for further surgery.
To minimize the need for secondary surgery to treat the cancer, a preoperative MRI scan may be done to locate all the tumor and ensure there are no surprises in remaining breast tissue. As the remaining tissue is more or less scrambled during oncoplasty, it is really important to know the full extent of disease prior to the primary surgery.
Q: What does the breast reduction part of the surgery involve? Are the nipples and areolae moved?
A: Prior to operation, patients are marked in the preoperative holding area with the typical breast reduction pattern markings. The patient then goes to the operating room and goes to sleep with general anesthesia.
The breast surgeon begins with removing the tumor and an ample margin of healthy tissue. Oncoplasty generally involves especially good margins, which ensure adequate tumor removal. During this phase, the lymph nodes are checked as well. Either a sentinel lymph node or a complete axillary dissection can be paired with an oncoplastic reduction, depending on what is indicated.
When the oncologic surgery is complete, the plastic surgeon comes in, assesses what tissue remains, and reshapes a smaller, more elevated, and naturally rounded breast. The nipple-areolar complex remains attached to the underlying breast tissue in most cases, and is moved up higher on the chest wall.
If only one breast is treated for cancer, the other breast is often reduced at the same surgery. This way the patient is able to undergo removal of her cancer and complete her reconstruction in just one operation. This is all done using the patient's own tissue.
Q: What kind of scars are created by the breast reduction?
A: There are two main types of incisions used in breast reduction, the "lollipop" and the Wise or "anchor" pattern. The lollipop scar is a circle around the areola and then a straight line down to the fold under the breast, resembling a lollipop. The anchor is the same circle around the areola and straight line down. However, the line also travels along the fold under the breast. This looks somewhat like an anchor; hence, its name.
The baseline shape of the breast, tumor location, and desired postoperative size will help the patient and her surgeons determine which incision is most appropriate.
We combine sound concepts of cancer removal with
the most aesthetic approaches for breast reduction.
Q: Who is an ideal candidate for oncoplastic breast reduction?
A: The best candidates require a large-volume resection and have symptoms of macromastia (heavy, large breasts), including chronic headaches, back pain, neck pain, shoulder grooving, or rashes under the breast. Patients with moderate- to large-sized breasts are still potential candidates. Also, oncoplastic reduction is possible in patients who have had prior breast surgery.
Q: Who is not a good candidate for oncoplastic breast reduction?
A: Women with small breasts, patients in whom it is not possible to achieve negative margins with repeated lumpectomy, and women who smoke are not good candidates.
Q: If only one breast is affected by cancer, how is symmetry with the healthy breast achieved?
A: Following completion of the oncoplastic reduction on the side with breast cancer, the opposite breast is then reduced to match in the standard breast-reduction fashion during the same operation. This way there is only one time under anesthesia for the patient.
Q: Since breasts may shrink or tighten as a result of radiation therapy, how can oncoplastic breast reduction ensure symmetry if only one breast requires radiation after surgery?
A: It is impossible to predict how a breast will respond to radiation therapy, whether or not reconstruction has been performed. That said, decrease in the size of the radiation-treated breast is more common. Therefore, we will often leave that side slightly larger in order to account for this. It is rare for a secondary operation to be required to enhance breast symmetry if changes due to radiation are marked.
Q: Is oncoplastic breast reduction only for women who have fully developed breasts? Can younger women qualify?
A: Oncoplastic breast reduction and traditional breast reduction are only possible for women with fully developed breasts. This tends to occur in the late teen years. Mostly all women who are diagnosed with breast cancer are older than this.
Q: What is the Stony Brook difference with regard to having oncoplastic breast reduction?
A: Stony Brook Medicine's breast surgeons are experts in all types of cancer surgery, and our plastic surgeons are very experienced in different types of breast reduction procedures. This collective experience translates into the best possible outcomes.
|"A team approach between reconstructive and breast surgeons produces positive long-term oncologic results as well as satisfactory cosmetic and functional outcomes, rendering oncoplastic breast reduction a favorable treatment option for certain patients with breast cancer." — Michelle Milee Chang, Tara Huston, Jeffrey Ascherman, Christine Rohde. "Oncoplastic Breast Reduction: Maximizing Aesthetics and Surgical Margins," International Journal of Surgical Oncology|
For more about oncoplastic options, visit the American Society of Plastic Surgeons. For consultations/appointments with our oncoplastic breast specialists, call the Carol M. Baldwin Breast Care Center at 631-638-1000.